Surgical and Radiologic Anatomy

, Volume 37, Issue 3, pp 255–258 | Cite as

Anatomical study of phrenic nerve course in relation to neck dissection

  • Tomohiro Hamada
  • Akinobu Usami
  • Asuka Kishi
  • Hideki Kon
  • Satoshi Takada
Original Article
First Online:
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Accepted:

Abstract

The present study sought to clarify the course of the phrenic nerve and its correlation with anatomical landmarks in the neck region. We examined 17 cadavers (30 sides). In each, the phrenic nerves was dissected from the lateral side of the neck, and its position within the triangle formed by the mastoid process and sternal and acromial ends of the clavicle was determined. The point where the phrenic nerve arises in the posterior triangle was found to be similar to the point where the cutaneous blanches of the cervical plexus emerge at the middle of the posterior border of the sternocleidomastoid muscle. In the supraclavian triangle, the phrenic nerve crosses the anterior border of the anterior scalene muscle near Erb’s point where the superficial point is 2-3 cm superior from the clavicle and posterior border of the sternocleidomastoid muscle. The phrenic nerve arises in the posterior triangle near the nerve point, then descends to the anterior surface of the anterior scalene muscle in the supraclavian triangle. It is necessary to be aware of the supraclavian triangle below Erb’s point during neck dissection procedures.

Keywords

Phrenic nerve Posterior triangle Supraclavian triangle Nerve point Erb’s point 
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Notes

Acknowledgments

This work was supported by JSPS KAKENHI Grant Number 25861973.

Conflict of interest

The author declares no conflicts of interest.

References

  1. 1.
    Bigeleisen PE (2003) Anatomical variations of the phrenic nerve and its clinical implication for supraclavicular block. Br J Anaesth 91:916–917CrossRefPubMedGoogle Scholar
  2. 2.
    Bocca E, Pignataro O, Sasaki CT (1980) Functional neck dissection, a description of operative technique. Arch Otolaryngol 106:524–527CrossRefPubMedGoogle Scholar
  3. 3.
    Economou SG, Economou TS (1996) A radical dissection. Atlas of surgical technique. W. B. Saunders Company, Philadelphia, pp 16–25Google Scholar
  4. 4.
    Erb W (1883) Handbook of electro-therapeutics. William wood and Company, New York, pp 121–134Google Scholar
  5. 5.
    Franko OI, Khalpey Z, Gates J (2008) Brachial plexus trauma: the morbidity of hemidiaphragmatic paralysis. Emerg Med J 25:614–615CrossRefPubMedGoogle Scholar
  6. 6.
    Liebgott B (2011) The neck. The anatomical basis of dentistry, 3rd edn. MOSBY, Maryland, pp 133–166Google Scholar
  7. 7.
    Loukas M, Kinsella CR Jr, Louis RG Jr, Gandhi S, Curry B (2006) Surgical anatomy of the accessory phrenic nerve. Ann Thorac Surg 82:1870–1875CrossRefPubMedGoogle Scholar
  8. 8.
    Matsumura H, Kumaki K (1996) Morphogenesis of the subclavian vein relative to the course of the nerve to the subclavius muscle and the phrenic nerve. Acta Med Biol 44:13–18Google Scholar
  9. 9.
    Moore KL, Dalley AF (2006) Nerves of the lateral cervical region. Clinical oriented anatomy, 5th edn. Lippincott Williams and Wilkins, Baltimore, pp 1061–1064Google Scholar
  10. 10.
    Paraskevas GK, Raikos A, Chouliaras K, Papaziogas B (2011) Variable anatomical relationship of phrenic nerve and subclavian vein: Clinical implication for subclavian vein catheterization. Br J Anaesth 106:348–351CrossRefPubMedGoogle Scholar
  11. 11.
    Schneider CA, Rasband WS, Eliceiri KW (2012) NIH image to Image J: 25 years of image analysis. Nat Methods 9:671–675CrossRefPubMedGoogle Scholar
  12. 12.
    Shiozaki K, Abe S, Agematsu H, Mitarashi S, Sakiyama K, Hashimoto S, Ide Y (2007) Anatomical study of accessory nerve innervation relating to functional neck dissection. J Oral Maxillofac Surg 65:22–29CrossRefPubMedGoogle Scholar
  13. 13.
    Snell RS (2007) Cervical plexus. Clinical anatomy, 7th edn. Lippincott Williams and Wilkins, Baltimore, pp 745–746Google Scholar
  14. 14.
    Standring S, Berkovitz KB, Shah P et al (2004) Neck and Diaphragm and phrenic nerve. In: Gray’s Anatomy, 39th edn. Elsevier, Churchill Livingstone, pp 534, 1084Google Scholar
  15. 15.
    Tubbs RS, Loukas M, Salter EG, Oakes WJ (2007) Wilhelm Erb and Erb’s point. Clin Anat 20:486–488CrossRefPubMedGoogle Scholar
  16. 16.
    Tubbs RS, Salter EG, Oakes WJ (2005) Anatomical landmark for nerves of the neck: a vade mecum for neurosurgeons. Neurosurgery 56:256–260CrossRefPubMedGoogle Scholar
  17. 17.
    Yaddanapudi S, Shah SC (1996) Bilateral phrenic nerve injury after neck dissection: an uncommon cause of respiratory failure. J Laryngol Otol 110:281–283PubMedGoogle Scholar

Copyright information

© Springer-Verlag France 2014

Authors and Affiliations

  • Tomohiro Hamada
    • 1
  • Akinobu Usami
    • 2
  • Asuka Kishi
    • 2
  • Hideki Kon
    • 1
  • Satoshi Takada
    • 1
  1. 1.Department of Oral and Maxillofacial SurgeryOhu University School of DentistryKoriyamaJapan
  2. 2.Department of Morphological BiologyOhu University School of DentistryKoriyamaJapan

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